Fact sheet on Severe Acute Malnutrition and MSF’s key achievements in Darbhanga.

Key Facts:

• Severely Acute Malnutrition (SAM) is described as a condition that predisposes a child to a weak immune system making him/her vulnerable to all kinds of chronic illnesses. [1]^,[i]

• While acute malnourishment results from sudden or immediate lack of access to food, chronic malnourishment sets in due to food shortage over a prolonged period of time.
• There are varying degrees of severity of acute malnutrition but in its severest form, a child faces nearly nine times higher the risk of dying than his/her healthy counterpart.[2]
• Body measurements interpreted in comparison to a reference population, such as weight-for height (W/H) or mid-upper arm circumference (MUAC) are relied upon to diagnose acute malnutrition.
• SAM means a child has very low weight ( in relation to his/her height when compared to the WHO child growth chart standards, or a MUAC reading of , along with clinical indicators such as oedema.  
• Ready-to-use Therapeutic Food (RUTF) has revolutionized the treatment of severe malnutrition – providing foods that are safe to use at home and ensure rapid weight gain.

Global Scenario[3]:

• 6.3 million children under the age of five died of malnutrition in 2013 which translates into 45% of all child deaths.
• Children in sub-Saharan Africa are more than 15 times more likely to die before the age of five than children in developed regions.
• Close to 1.3 million children die every year in India with the country bearing the highest rates of malnutrition in the world.
• Out of 19 million severe acute malnourished children in all developing countries, 8 million (42%) are in India. This means, at any one point in time, an average of 8 million (42%) children in India (5 years of age) suffers from severe wasting, which is the most common form of SAM. This number constitutes one-third of the global burden[4]

MSF’s role in effective control of malnutrition in Bihar:

• In Bihar 27.1% five year olds are wasted and 8.3% have SAM.[1]
• According to a report by the Integrated Child Development Scheme, Government of India (GoI), Bihar consists of 2 million underweight children. Off these 500,000 are severely malnourished.[2]

• MSF is an international medical humanitarian organisation working in India since 1999.
• MSF has been working in Bihar’s Darbhanga district since 2009 providing curative treatment to children suffering from SAM. So far, MSF has admitted more than 17,000 SAM patients, aged six months to five years, in its community-based treatment programme in the district, called Community Management of Acute Malnutrition (CMAM).
• Under CMAM Accredited Social Health Activists (ASHAs) in the villages identify and screen children for SAM before referring them to the nearest primary health centre (PHC), where trained government nurses provide the necessary nutritional and medical care.
• The CMAM model incorporates village level, block level and district level nutritional care and treatment of severe acute malnutrition in Darbhanga district. The CMAM model seeks to provide identification, treatment and referral (when necessary) of all children suffering from SAM within the community (See diagram below).
• Among the patients admitted, close to 90% was less than two years old, 87% belonged to the poorest and most vulnerable castes and more than 60% were females.
• Only cases with medical complications require in-patient care at a facility that provides specialised care, like MSF’s Nutritional Rehabilitation Unit (NRU) or Malnutrition Intensive Care Unit (MICU).
• Set up in March 2014 inside the Darbhanga Medical College and Hospital, the MICU provides treatment to SAM patients with severe medical complications.
• A June 2014 survey conducted by MSF in collaboration with the District Health Society in Darbhanga recorded the prevalence of SAM in the district as 3%. This represents close to 20,000 under five children in the district as severely affected by the condition.